Program Operations Manual System (POMS)

HI 01140.020 Appeals Status Information

The level of the Income-Related Monthly Adjustment Amount (IRMAA) appeal determines the jurisdiction for who determines the appeal. SSA field offices handle all reconsiderations. The Department of Health and Human Services (HHS) has jurisdiction over all IRMAA appeals past the reconsideration level. The Southeastern Program Service Center (SEPSC) has a centralized unit that controls all appeals past the reconsideration level. When a beneficiary requests status of an IRMAA appeal, you have to determine the level and jurisdiction in order to provide accurate information.

Enter the Beneficiary’s Own social security number (SSN) and click on the search button.

Select “Query Record Details.”

The first screen in the path is the “General” screen. On this screen, the fields are:

the beneficiary’s SSN,

the name,

the filing date, which is the date the reconsideration was filed,

the notice determination date, which is the date on the notice which they are appealing,

the office code,

the area office code,

the MOD (if applicable),

the unit (if applicable),

the appeal level, and

the status of the appeal.

To view more details on the appeal, select “Detail” at the top of the screen. On this screen, the fields are:

the beneficiary’s SSN,

the appeal status,

the level of appeal,

the reason for the appeal, which can be disagrees with the constitutionality of the law, disagrees with level, non-qualifying event (NQE), or other,

the date the appeal was reported to SSA,

the event description, which can be initial determination, new initial determination-LCE, new initial determination-tax information, or new initial determination-non qualifying event,

the date of the event, which is the date of the event being appealed, and

Remarks – this field will appear if remarks are present.

To view information concerning the beneficiary’s attorney or representative, select “Attorney/Rep” at the top of the screen.

To view information concerning the history of the appeal, select "History" at the top of the screen.

To view the final disposition of the appeal, select "Disposition" at the top of the screen.

Inform the beneficiary if the reconsideration is still pending or if there is a decision. You can inform the beneficiary what the decision is using the information provided on the "General" and "Disposition" screen.

If the beneficiary still has questions about the reconsideration, set up an appointment with the field office of jurisdiction in the 800 Number PE Appointment System using Event Type 9 "Medicare Issue" and select Event Title 5 "Title 18." In REMARKS on the PE Appointment screen, explain that the beneficiary has questions about his or her IRMAA reconsideration.

The beneficiary states he has information to add to his pending reconsideration.

The first screen in the path is the “General” screen. On this screen, the fields are:

the beneficiary’s SSN,

the name,

the filing date, which is the date the reconsideration is filed,

the notice determination date, which is the date on the notice that they are appealing,

the office code,

the area office code,

the MOD (if applicable),

the unit (if applicable),

the appeal level, and

the status of the appeal.

To view more details on the appeal, select “Detail” at the top of the screen. On this screen, the fields are:

the beneficiary’s SSN,

the appeal status,

the level of appeal,

the reason for the appeal, which can be disagrees with the constitutionality of the law, disagrees with level, or other

the date the appeal was reported to SSA,

the event description, which can be initial determination, new initial determination-LCE, new initial determination-tax information or new initial determination-non qualifying event.

the date of the event, which is the date of the event being appealed, and the Remarks if annotated.

To view the final disposition of the appeal, select “Disposition” at the top of the screen.

Determine if the appeal is still pending based on information provided on the “General” and “Disposition” screen.

If we have not made a decision, refer the beneficiary to the office of jurisdiction.

C. Referrals to the Office of Medicare Hearings and Appeals (OMHA) or the Medicare Appeals Council (MAC)

If a beneficiary has questions concerning a pending appeal or about appealing a decision other than a reconsideration, you must determine the location of the pending case (i.e., SEPSC or an HHS location).

If…

Then

The case is pending in SEPSC

Send a Modernized Development Worksheet (MDW) documenting Workload Support Unit “WSU” as the unit in the UNIT field.

Use “C34” in the FO field and show “IRMAA HEAR” as the ISSUE.

In REMARKS, advise that the beneficiary is requesting status.

Request SEPSC to provide the beneficiary with status.

Advise the beneficiary that someone from SEPSC will contact him.

No hearing is established in the IRMAA tracking system

Send an MDW documenting “WSU ” as the unit in the UNIT field.

Use “C34” in the FO field and show “IRMAA HEAR” as the ISSUE.

In REMARKS, enter “IRMAA HEARING FILING ALLEGED, SYSTEM NIF.”

Request that the WSU provide the beneficiary with status.

Advise the beneficiary that someone from SEPSC will contact him.

The IRMAA Appeals Tracking System shows the case is located in HHS and the beneficiary is requesting status or providing new information; such as change of address or phone number to add to the file.

Advise the beneficiary to contact the OMHA central docketing unit at (855) 556-8475 or the MAC office directly. The information showing the office handling the appeal is located on the notice from OMHA or the MAC confirming receipt of the appeal request. If the beneficiary has not received a notice from OMHA or the MAC and more than 60 days has passed, advise the beneficiary to contact OMHA or the MAC at (866) 365-8204 or (202) 565-0100.